Multiple Scale of Complexity for Anorectal Fistulas

Abstract

Background: Anorectal fistulas are frequently prevalent proctological entities, in which the complexity is frequently garbled. Objective: To create a scale of complexity for fistulas based on identification, medical history, physical examination, and ultrasonography findings. Design: A retrospective and descriptive study of a prospectively maintained database. Setting: A single medical group performed three-dimensional endoanal ultrasonography at two different tertiary care hospitals in Caracas, Venezuela. Patients and Methods: All patients who underwent anorectal three-dimensional endoanal ultrasonography at the two hospitals between 2010 and 2017 were included in the study. We created an arbitrary numerical scoring system ranging from 0 to 14 points, which classifies the structure of fistulas as simple, intermediate, and complex. The chi-squared test performed with Statistical Program of Social Sciences was used to establish the significance level of P < 0.005. Sample Size: a total of 1173 patients were evaluated, and perianal fistulas were identified in 989 patients. Results: Of the 232 intersphincteric fistulas, 75.86% were simple, 22.41% were intermediate, and 1.72% were complex. Of the 295 lower transsphincteric fistulas, 51.19% were simple, 42.71% were intermediate, and 6.10% were complex. Of the 327 high transsphincteric fistulas, 17.74% were simple, 59.94% were intermediate, and 22.32% were complex. Of the 48 extrasphincteric fistulas, 66.67% were intermediate and 33.33% were complex. Finally, of the 18 suprasphincteric fistulas, 50% were intermediate and 50% were complex. Conclusions: The complexity of fistulas may not be easy to determine, even in cases requiring further complementary studies. The application of our scale helped to prevent the factors that may be responsible for the deterioration of the complexity of fistulas, with a statistically significant difference compared to the classic Goodsall's classification, based exclusively on the anatomy of the fistula tract. Limitations: A single operative group study without surgical usefulness validation that warrants a further multicentric randomized study. Conflict of Interest: The authors have no conflict of interest to declare.